Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 016002469 | IL |
N | 222Z00000X | Podiatrist | 016002469 | IL |
N | 2081S0010X | Sports Medicine | 016002469 | IL |
N | 213ES0000X | Sports Medicine | 016002469 | IL |
Y | 213ES0103X | Foot & Ankle Surgery | 016002469 | IL |
N | 213ES0131X | Foot Surgery | 016002469 | IL |
NPI | 1023016623 |
---|---|
Provider Name | Lowell Scott Weil SR. |
First Address | Des Plaines, IL 60016-1250 |
Second Address | Des Plaines, IL 60016-1250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 31/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1710965314 | (05) | IL |
201255100A | (05) | IN |
60000380 | BCBS (01) | IL |
6039870 | CIGNA (01) | IL |